FACILITATING RELEVANCE OF CLASSROOM PEDAGOGY AND PROFESSIONAL NEEDS IN AN EFL MEDICAL ENGLISH
Paulus Widiatmoko
Universitas Kristen Duta Wacana, Yogyakarta, Indonesia Widiatmokoyk@gmail.com
Abstract: ESP classes are designed to teach language and communication skills that language learners need or will need in their disciplines or professions (Basturkmen, 2010). Applied to Medical English, these include oral communication with foreign patients during Medical examination in which aspects of language functions, Medical content, and cross-cultural appropriateness are elaborated. In this study classical sessions of practicing language functions for 48 Medical students are facilitated by English teachers and doctors. Subsequently, individual skill-lab sessions encouraging a real-like practice are administered, each assisted by a native speaker as an acting patient and a resource for cultural learning, a doctor in dealing with the Medical procedures, and an English teacher for coping with difficulties in the target language skill. Another skill-lab class reviewing these three stages ends the sessions. Students and collaborators’ attitudes are assessed by means of questionnaires and interviews resulting in positive admittance of relevance between the course and professional needs specifically in relation with objectives, material selections, teaching methods. Other benefits and suggestions for the program development are proposed. The collaborative works and teaching methods in this study supposedly provide a model of ESP teaching practice to facilitate relevance between classroom pedagogy to students’ future professional needs.
Keywords: Medical English, Relevance, EFL, ESP
Introduction
One of the objectives of English for Specific Purposes (ESP) is preparing learners’ English skills for their future professional needs. Dudley-Evans and St John (1998) point out that one of the main concerns of ESP deals with preparing learners to communicate effectively in the tasks prescribed by their study or work situation. Accordingly, Basturkmen (2010:8) states that in an ESP situation, it is understood that learners would want to achieve ‘real world’ objectives, the ones requiring specific linguistic competencies. For Medical students, being able to communicate effectively with people from various cultural backgrounds, including from English speaking countries would be an enhancement of their future professionalism. Despite practicing language functions for communication, comprehensive aspects of Medical-related discipline concerning clinical procedures and cross-cultural awareness are supposedly well elaborated. Language development is, therefore, seen as the means to the ends but not as the end in itself.
Doctors communicate with patients basically in three main procedures of clinical conversations. First, taking history which requires language expressions to ask questions, confirm, and dig out the patients’ complaints, Medical records, life styles, and other relevant assessments. Secondly, physical examinations in which doctors mainly describe the procedures, give instructions, and facilitate patients’ comfort. Lastly, diagnosing and educating patients. In this phase, a doctor is supposed to describe the diagnosis of what the patients are suffered from and educate them by suggesting some do’s and don’ts and giving prescribed medicines. Practicing the language functions to perform these procedures prepares learners for communicative competence which Richards (2006 p3) formulates as “being able to use the language for meaningful communication”.
Language learning is closely associated with culture learning. Piasecka (2011) exemplifies that learning a language is closely associated with learning culture. Therefore, revisiting cultural aspects of native speakers speaking the language is considered necessary. It is further proposed that the purposes of learning foreign languages “have evolved from linguistic through communicative to intercultural and intercultural communicative competence” (Piasecka, 2011 p22). Developing linguistic competence focuses on language as a code, while communicative competence results from interpreting language as a communication system. Understanding language as a social practice has lead to the emergence of intercultural communicative competence (Scarino 2010 cited in Piasecka, 2011). Interacting effectively with foreign patients in English, these future doctors have to develop this intercultural communicative competence. Specifically, they have to cope with three different cultural contexts, namely their first language culture, their foreign language culture and the culture of their interlocutor.
organized and related to culture on a number of levels: the speech community, the speech situation, the speech event, and the speech act. Hymes (1986: 56) defines these levels as follows. First, speech community is “a community sharing rules for the conduct and interpretation of speech, and rules for the interpretation of at least one linguistic variety”, whereas speech situation is an activity that is “somehow bounded or integral”, but does not necessarily require speech, or rules for using speech. A speech event, on the other hand, is a bounded event that is “directly governed by rules or norms for the use of speech”. Some culturally recognizable way of speaking is thus part of the definition of the speech event. A speech act is “a minimal unit of speech that accomplishes some action: question, request, order, threat, compliment, etc”.
Built upon the above framework, this study reports a case of program collaborating doctors, English native speakers, and ESP teachers to facilitate relevance between classroom pedagogy with professional needs of doctors to communicate with patients in a clinical examination. More comprehensive discussion on the types of collaboration, practicing sessions, and assessment would be presented. Then, students’ and collaborators’ attitudes towards this program relevance to their needs were assessed and analyzed descriptively.
Collaborations in Language Review and Skill-Lab Sessions
Collaboration describes “how people work together rather than what they do as a dynamic, interactive process among equal partners who strive together to reach common goal in increasing achievement for all learners” (Moreillon, 2007 p4). This study adapts Dudley-Evans and St John (1998) model of collaboration between content and ESP teachers in which a mutual interest on the part of both teachers contribute their experience with the common goal that both perspectives should be the advantage of the students’ learning.
Specifically, collaboration in this course is designed in three main steps. First, it is the doctor who provides the topics as the reference points to introduce the linguistics side designed by the ESP teacher. The linguistics needs are determined to perform clinical consultations which are organized into some stages. First, initiating the consultation in which language functions to build rapports are used such as greeting the patient, introducing oneself as a doctor, and clarifying the roles. Making human connection by asking questions such as
you look so pale… and stepping to exploration of the patients’ problems by asking what brings you today?
Establishing patients’ concern and understanding health complaints from the patients’ perspective are also considered necessary. It proceeds with gathering information covering the patients’ personal information, Medical history, symptom details and other related questions. Conducting physical examination then follows in which language expressions such as giving instructions and asking questions to confirm are used. Vocabularies of parts of the body especially anatomical and symptom terms are also elaborated. Based on the results of previous steps, explaining diagnosis and educating patients elaborate language expressions to deal with identification of disease, treatment plans or course of actions, and giving advice.
A related study is conducted in New Zealand in which a need analysis for training non-English speaking doctors proposes the importance of identifying features of discourse for this communication needs (Basturkmen, 2010). These include a number of pragmatic functions and key lexical areas including idiomatic ways of describing pain and naming symptoms. Transitions as signals the upcoming discourse, feedback responses to show responsiveness to what the patients say, expressions to deal with sensitive issues, the use of hedging are recommended to be elaborated. Samples of language use drawn from this discourse features are shown in table 1.
Features Categories Samples of language use
Key pragmatic functions
Showing empathy
Asking about symptoms
Responding to the patient’s concerns
So you lost your husband six months ago and you are finding it hard to cope, physically and mentally. This must be difficult for you.
I’d just like to ask some questions if that’s’ OK? Any other things you’re noticing nowadays?
I understand the concerns but I’d just like to as few more questions to understand the situation.
Lexical fields Idiomatic ways of describing pain
Idiomatic ways to describe symptoms
A dragging pain, shooting pain, it comes and goes, the pain is sharp
Discourse transitions
What next to happen now is an examination (rather than I now need to examine you.
The next step is now to check you over.
Eliciting feedback responses
Am I being clear in all this? How does this sound to you?
Dealing with particularly sensitive issues
Do you mind if I ask you…?
Do you think we can do something about your smoking?
I know a lot of people at your age have…
Hedging I’d just to talk to you about…
[image:3.595.72.524.72.214.2]Do you mind if I ask to you few things that may not seem related..
Figure 1: samples of salient discourse features and illustrative samples of language use (Basturkmen, 2010) Secondly, both ESP teachers and doctors facilitate the review and practice of the language functions described earlier. The language review sessions, as presentation and practice of language functions in doctor-patient clinical communication, are assigned into three sessions each lasts for 120 minutes, covering three major topics: opening and history taking, conducting physical examinations, providing diagnosis and educating. Functional type of syllabus is adopted in which language functions are the organizing principles.
In these sessions doctors and ESP teachers collaborate to facilitate the students’ practice. The ESP teachers take a bigger proportion in reviewing the language functions, leading the practice, and managing the lesson phase. The doctors support the practice by monitoring the use of correct procedures and medical terminologies. Followed by 48 students, group and pair works are mostly used to engage them practicing the language functions using various types of material such as reading texts, listening passages, and videos to provide illustrations of the Medical procedures and media for the student to practice.
Finally, three sessions of skill-lab encouraging a real-like practice of the three procedures of doctor-patient clinical communication are administered. Students are assigned into groups of eight for more intensive opportunity to perform the procedures individually. Each group is assisted by a native speaker as an acting patient and a resource for cultural learning, a doctor in dealing with the Medical procedures, and an English teacher for coping with difficulties in the target language skill. A health case is given for each session selected by the doctors. After each performance for 10-15 minutes, comments and input are given in accordance with the collaborators’ assigned roles. Rubrics assess the students’ performance and an evaluation sheet is provided for the students to keep. In this way, collaborators’ subjectivity is minimized and each student’s progress could be monitored. Another skill-lab class reviewing and elaborating these three stages ends the sessions.
Skill-lab sessions appear to be one of the most essential parts of this program. The students have to perform the procedures individually combining their medical savvy and language proficiency. Three collaborators assist them in terms of Medical procedures, English performance, and culture appropriateness. They give comments and criticisms at the end of each performance. Personality styles of the collaborators sometimes affect their communication strategies. Moreover, different expectation and perception in part of the collaborators in some aspects of the communication such as the linguistics correctness among groups of skill lab often bring the concern for the students. Peer pressure seems also affect some of the students’ performance.
The students’ communicative competence is assessed by their ability to perform the procedures they have practiced during the language review and skill-lab sessions. Performing tasks of history taking, physical examination, and giving diagnosis/education, each student has to fulfill three criteria: correct Medical procedures covering accurate diagnosis of health problem to education, then appropriate use of the Medical equipments, and appropriate use of the language functions. The first two criteria are assessed by the doctors using checklists, whereas the last one is for the ESP teachers to evaluate based on rubrics.
Students’ and Collaborators’ Attitudes
This program is part of a course in Medical department entitled “Kedokteran Pariwisata” often translated as tourism Medicine. All of the students have been assessed in a placement test as part of the university language teaching policy and some have attended an English matriculation program called Introduction to College English (ICE). It is a three-level course designed as a part of language-in-education policy to equip struggling students in need of English foundation before they take ESP (English for Specific Purposes) classes including Medical English. This program was initiated based on the concern to prepare these students to meet the demand of ESP objectives such as being able to demonstrate oral or written production skills on topics related to their disciplines.
objective, material selections, and teaching methods, etc. Specifically, the students agree with the objective and the importance of the course. This objective is claimed to be relevant with the teaching methods. Moreover, the collaborators comprising native speakers, doctors, and ESP teachers admittedly facilitate their practice.
Learners’ agreement on the necessity of the course 4.71 Learners’ understanding the objectives of the course 4.55 Encouragement of cultural learning by the native speakers 4.68 Accordance of skill-lab practicing methods with their future needs 4.45 The doctors’ roles to provide more comprehensive understanding on the Medical
procedures in the skill-lab sessions
4.32
The ESP instructors’ roles to help learners correct their language errors in the skill-lab sessions
4.32
Relevance between the objectives of this course with the teaching methods in the language review and skill lab sessions
4.23
Learners’ perceived ability to handle complexity of the patients’ health complaints 4.00 Necessity of language review sessions to prepare learners’ skill-lab performance 3.94 Appropriateness of language expressions with the needs of examining foreign patients 3.94 Techniques of practicing language expressions in the review sessions are perceived
effective
3.71
[image:4.595.71.529.115.323.2]The numbers of meeting in language review sessions have been perceived appropriate 3.32 The numbers of skill lab practice have been perceived appropriate 3.19
Table 1: findings of student questionnaire.
Responses to the open ended questions reveal several benefits and inputs towards the course. First, it contributes to learning culture of the target language facilitating more comprehensive understanding non-technical aspects of examining foreign patients.
“Now I know better about the habits and culture of foreign patients”. “I can see the difference between examining local and foreign patients”. “I am happy to learn from native speakers”.
“They help us learn lots of things including their culture”. “It is easier and clearer”.
“The native speakers improve my speaking skill”.
Furthermore, students admit relevance of this course for their future needs.
“The learning method, I think, is effective because it integrates Medical competence as the core discipline and English competence as the supporting one”.
“I feel that this course has prepared me to be a doctor capable of taking care of foreign patients”.
Some students also admit that the course has informed them of their current English competence. “I realize now that I need more practice”
“I have to practice harder”
“I think I need to improve my speaking skill, especially y grammar” “I have to learn speaking English better”
Aside from the benefits, other inputs and comments are suggested. Most of them acknowledge that the time allocation for language review and skill-lab practice was not sufficient for intensive practice.
“There should be more time allocated both for the language review and skill-lab” “There should be another English class preparing for this course”.
There are also comments showing dissatisfaction with teaching techniques.
“Grammar is very important, but English teacher should take encouraging and positive perspective to correct students’ mistakes”.
“Doctor collaborators should focus more on the Medical procedure rather than on the language aspects”.
Interview with the collaborators suggest some perceived benefits of the practicing methods of this course. Three collaborators consisting of a doctor, a native speaker from USA, and an English instructor agree that this course has prepared the Medical students to communicate their future foreign patients. Specifically, there has been relevance between the objective formulations and the methods applied during the practicing sessions in attempt to achieve them. Secondly, this course has admittedly encouraged explicit culture learning by involving the native speakers. Furthermore, the collaboration is also perceived beneficial in enriching aspects of students’ learning. It is admitted, however, that collaborators should agreed on some practical procedures and techniques of assisting the students during skill-lab sessions such as in dealing with error corrections, grammar and pronunciation correctness, etc.
The findings of this study expectedly offer evaluation for this course preparation, conduct, and assessment. Furthermore, investigation in some related area seems pertinent. For instance, it appears necessary to evaluate how this course could connect other language-in-education policy of the university. It may also beneficial to investigate interrelating factors and aspect facilitating attainment of the course objectives.
Conclusion
Multi-faceted aspects of ESP (English for specific purposes) integrate discipline-related content and English skills. In Medical English this could be facilitated by collaborating expertise of doctors and ESP teachers supported by the native speakers. Elaboration of the content, language, and culture learning facilitated by the collaborators appears to contribute to the relevance of this course to the attainment of the course objectives.
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